Treating stroke involves almost every clinical department at Wyoming Medical Center, starting with emergency responders, and including close collaboration of care between ER nurses and physicians, radiology, laboratory, pharmacy, ICU, neurology, therapies, case managers and more. Neurologists take the first call in a Code Stroke and coordinates care with the stroke team.

In this interview, Dr. Mosada talks about the advancements in stroke care and why there is more hope for stroke patients today than ever before.

Where did you grow up, and how did you become interested in medicine?

I am from a small town in the Philippines, and I was just a curious kid by nature. I wondered how the body works. My parents encouraged me to pursue medicine in high school and after graduation.

I moved to the United States in 1990 after medical school. I decided to specialize in neurology because my father had a stroke at a young age. I think he was in his 50s. His care was mismanaged, and I said ‘Never again.’ I wanted to try to prevent people from being misdiagnosed and mistreated for a stroke.

What do you think should have been done differently with your dad?

Well, he went to the hospital with a headache and when they took his blood pressure it was high. They managed him for that, and nothing else was considered. He had a series of TIAs (Transient Ischemic Attack, or temporary blockage of blood flow to the brain) and then he had the stroke.

WHAT ARE THE DIFFERENCES IN STROKE DIAGNOSIS AND TREATMENT BETWEEN NOW AND THEN?

The biggest thing that has changed since then is that we didn’t really know much about stroke prevention or risk factors. Now, I think the main goal of treating stroke is preventing it. So we have all of the parameters now: We can check for your risk factors and treat them if necessary. Things like blood pressure, cholesterol, sugars and counselling patients to quit smoking. Aside from all those clinical parameters, your family history is the second factor that we can look at to determine preventative measures.

BOARD CERTIFICATIONS

Neurology

Contact

Call (307) 265-4343 for an appointment or referral.

Fortunately, now, if you have a stroke we can do something about it immediately. We can administer clot-busting medicine, tPA, which is still the gold standard for managing a stroke. If that doesn’t stop the stroke, we can deploy catheters that can remove the clot from the blocked blood vessel. There are also studies that show the treatment window for strokes is longer. Today, patients with strokes are given chances. It is not 100 percent, but they are given chances.

Finally, rehabilitation and physical therapy have evolved so much and those things were not given to my father when he had a stroke. He was not given the preventive, he was not given the proper treatment immediately and he didn’t have good therapy.

What kind of deficit did your father’s stroke cause?

He had right-sided weakness. He was able to walk and speak, but it really affected him. He was a teacher. He was a very different person after that stroke. It changed the dynamics of his life, his outlook.

What was it like for you, after watching what your father went through, to see this evolution in stroke care?

You know, there is hope for more stroke patients. There are degrees of stroke. My father’s stroke was not that severe; it was a small stroke. Unfortunately, if you have a big stroke that involves one side of the brain, then unfortunately you cannot do much about it. We will still try. And, at least we can minimize the deficit the patient will have afterwards.

Before moving to Casper, you practiced in Aberdeen, S.D. It’s a rural area, similar to Natrona County. What are the challenges of practicing life-saving medicine in populations that are so spread out?

Around Aberdeen, there are a lot of Irish and German descendants in the farming communities. They can be really stubborn. But we worked these communities to educate them to recognize the symptoms of stroke and to seek medical care, instead of trying to sleep it off. We sent physicians out to EMS crews in surrounding communities to teach them about stroke symptoms, what to do in case of stroke, and what not to do, etc.

When I was in Aberdeen, we increased the number of patients we saw for stroke during my tenure. Why? Because of patient awareness. They knew about the “golden hour” in stroke care when treatment has the best chance for working, because we made concerted efforts to educate them.